I can't tell if any of these patients had spasticity so it is impossible to tell the applicability to regular patients.
Effects of Intensive Arm Training With an Electromechanical Orthosis in Chronic Stroke Patients: A Preliminary Study
2011, Archives of Physical Medicine and Rehabilitation
Rodrigo C. de Araújo, PhD, Fábio Lúcio Junior, MSc, Daniel N. Rocha, PhD, Tálita S. Sono, MSc, Marcos Pinotti, PhD
de Araújo RC, Junior FL, Rocha DN, SonoTS, Pinotti M. Effects of intensive arm training with an elec-tromechanical orthosis in chronic stroke patients: a preliminary study. Arch Phys Med Rehabil 2011;92:1746-53.
de Araújo RC, Junior FL, Rocha DN, SonoTS, Pinotti M. Effects of intensive arm training with an elec-tromechanical orthosis in chronic stroke patients: a preliminary study. Arch Phys Med Rehabil 2011;92:1746-53.
ABSTRACT.
Objectives:
To evaluate the use of an electromechanical device, comprising an exoskeleton, a static orthosis, and a glove, for functional rehabilitation of the elbow and hand inpatients with hemiparesis, and to compare it with physicaltherapy rehabilitation.
Design:
Pretest posttest design.
Setting:
Rehabilitation laboratory.
Participants:
Volunteer sample of persons (N
12) with persistent hemiparesis from a single, unilateral stroke within the past 3 to 36 months.
Interventions:
The volunteers were randomly divided into 2groups. One group was treated with a conventional program of physiotherapy, and another group participated in a training program in which an electromechanical orthosis was used. All volunteers received 24 sessions, held 3 times a week for 8 weeks.
Main Outcome Measures:
Modified Ashworth Scale (MAS),Fugl-Meyer Assessment (FMA), and electromyogram (EMG)amplitude.
Results:
No statistical difference was found in the initial and final values of the MAS. Both groups showed a significant increase for the total scores of the FMA. However, only the group treated with the orthosis showed an increase in FMA scores related to the wrist and hand joint. The EMG analysis showed increased EMG amplitudes for all muscles in the group treated with the orthosis, whereas the group treated with physiotherapy showed gains in electromyographic activity only in the extensor digitorum communis. Intergroup comparison showed that the initial FMA scores of the wrist/hand were higher in the group treated with physiotherapy. However, after training, the scores in the group that used the orthosis were equivalent to those of the physiotherapy group.
Conclusions:
The results suggest that this device can be an auxiliary tool to help the conventional rehabilitation program of motor function of the affected upper extremity.Key Words: Cerebrovascular accident; Paresis; Rehabilitation; Upper extremity.© 2011 by the American Congress of Rehabilitation Medicine THE GROWTH IN LIFE expectancy has generated a significant increase in the worldwide elderly population and an associated increase in comorbidities related to aging.Among these, stroke is one of the main causes of death and functional incapacity in the world.1-4The World Health Organization estimates that the incidence of stroke in developed countries will grow approximately 30%(So going from 1 in 4 will have a stroke to 1 in 3 will have a stroke) between 2000 and 2025,5predicting that approximately 49 million individuals worldwide will survive stroke and live with a functional incapacity that will increase health care system expenses and significantly decrease the quality of life of these individuals.6Hemiparesis has been reported as the principal effect of stroke and occurs in more than 80% of all cases.7,8The degree of motor function recovery is strongly correlated with the severity and location of the lesion.9The recovery process maybe stimulated and molded by rehabilitation programs that use different techniques and exercises for motor relearning.10Published studies indicate that only 5% to 20% of stroke patients with hemiparesis regain upper extremity function11-13and that only 6% are satisfied with the level of functionality of the affected upper extremity.14Therefore, it is necessary to search for more effective therapeutics for the rehabilitation of these patients.Because of the limited success of traditional rehabilitation programs in restoring upper extremity function after stroke,researchers have been searching for other solutions, especially those using new technologies. Different research groups have developed robotic devices to assist in motor function recovery.15-20These devices allow the performance of repeated time specific tasks in a controlled and reliable manner, which has been demonstrated to be a determining factor in the facilitation of cortical reorganization, with a concomitant increase in motor ability and an improvement in functional activity performance.
16
Of the new devices, the most studied are the MIT-Manus,17MIME,18ARM-Guide,19NeReBot,4and ARMin.20Despite their good results in preliminary studies, these robotic devices have several drawbacks: they focus on the rehabilitation of the upper extremity proximal joints, have high costs, and do not allow the accomplishment of daily life activities. Therefore, the objective of this study was to evaluate the use of an electromechanical device, composed of an exoskeleton, static orthosis, and a glove, for functional rehabilitation of the elbow and hand in patients with hemiparesis, and to compare it with physiotherapeutic rehabilitation.
To evaluate the use of an electromechanical device, comprising an exoskeleton, a static orthosis, and a glove, for functional rehabilitation of the elbow and hand inpatients with hemiparesis, and to compare it with physicaltherapy rehabilitation.
Design:
Pretest posttest design.
Setting:
Rehabilitation laboratory.
Participants:
Volunteer sample of persons (N
12) with persistent hemiparesis from a single, unilateral stroke within the past 3 to 36 months.
Interventions:
The volunteers were randomly divided into 2groups. One group was treated with a conventional program of physiotherapy, and another group participated in a training program in which an electromechanical orthosis was used. All volunteers received 24 sessions, held 3 times a week for 8 weeks.
Main Outcome Measures:
Modified Ashworth Scale (MAS),Fugl-Meyer Assessment (FMA), and electromyogram (EMG)amplitude.
Results:
No statistical difference was found in the initial and final values of the MAS. Both groups showed a significant increase for the total scores of the FMA. However, only the group treated with the orthosis showed an increase in FMA scores related to the wrist and hand joint. The EMG analysis showed increased EMG amplitudes for all muscles in the group treated with the orthosis, whereas the group treated with physiotherapy showed gains in electromyographic activity only in the extensor digitorum communis. Intergroup comparison showed that the initial FMA scores of the wrist/hand were higher in the group treated with physiotherapy. However, after training, the scores in the group that used the orthosis were equivalent to those of the physiotherapy group.
Conclusions:
The results suggest that this device can be an auxiliary tool to help the conventional rehabilitation program of motor function of the affected upper extremity.Key Words: Cerebrovascular accident; Paresis; Rehabilitation; Upper extremity.© 2011 by the American Congress of Rehabilitation Medicine THE GROWTH IN LIFE expectancy has generated a significant increase in the worldwide elderly population and an associated increase in comorbidities related to aging.Among these, stroke is one of the main causes of death and functional incapacity in the world.1-4The World Health Organization estimates that the incidence of stroke in developed countries will grow approximately 30%(So going from 1 in 4 will have a stroke to 1 in 3 will have a stroke) between 2000 and 2025,5predicting that approximately 49 million individuals worldwide will survive stroke and live with a functional incapacity that will increase health care system expenses and significantly decrease the quality of life of these individuals.6Hemiparesis has been reported as the principal effect of stroke and occurs in more than 80% of all cases.7,8The degree of motor function recovery is strongly correlated with the severity and location of the lesion.9The recovery process maybe stimulated and molded by rehabilitation programs that use different techniques and exercises for motor relearning.10Published studies indicate that only 5% to 20% of stroke patients with hemiparesis regain upper extremity function11-13and that only 6% are satisfied with the level of functionality of the affected upper extremity.14Therefore, it is necessary to search for more effective therapeutics for the rehabilitation of these patients.Because of the limited success of traditional rehabilitation programs in restoring upper extremity function after stroke,researchers have been searching for other solutions, especially those using new technologies. Different research groups have developed robotic devices to assist in motor function recovery.15-20These devices allow the performance of repeated time specific tasks in a controlled and reliable manner, which has been demonstrated to be a determining factor in the facilitation of cortical reorganization, with a concomitant increase in motor ability and an improvement in functional activity performance.
16
Of the new devices, the most studied are the MIT-Manus,17MIME,18ARM-Guide,19NeReBot,4and ARMin.20Despite their good results in preliminary studies, these robotic devices have several drawbacks: they focus on the rehabilitation of the upper extremity proximal joints, have high costs, and do not allow the accomplishment of daily life activities. Therefore, the objective of this study was to evaluate the use of an electromechanical device, composed of an exoskeleton, static orthosis, and a glove, for functional rehabilitation of the elbow and hand in patients with hemiparesis, and to compare it with physiotherapeutic rehabilitation.
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